Where does resiliency fit into the residency training experience: a framework for understanding the relationship between wellness, burnout, and resiliency during residency training

Abstract

Background: Medical literature reports high rates of burnout among medical professionals. The terms wellness and resilience are often used interchangeably in the solution focused discussions. By confusing the terminology, the distinct role of resilience within residency training may be ill-appreciated. The objective of this paper is to define wellness, burnout, and resiliency and detail a proposed framework to explain how these terms manifest within residency training. Methods: MEDLINE and EMBASE searches were performed using the key words “resilience,” “residency,” “wellness,” and “burnout.” The search was limited to English language articles published between 2003-2017. Results: The authors propose a framework based on the literature review. This work supports the implementation of resilience-based interventions that enable residents to engage with workplace adversity in a healthy way, acquire skills during the process and avoid resource depletion and, ultimately, burnout.Conclusion: This framework can be used by residency programs to promote educators and residents’ understanding of the unique role of resilience within residency, and the importance of differentiating between wellness and resilience initiatives. Future research is required to study the utility of this framework.

Addressing the physician burnout epidemic with resilience curricula in medical education: a systematic review

“…However, recent literature on therapeutic stress management programs for medical students and residents have revealed mixed and inconsistent results, with overall unclear long-term benefits. In response, medical schools and residency programs have begun exploring alternate wellness interventions, aiming to prevent burnout long-term by fostering trainee resilience [72][73][74].…”

Skills-Based Programs Used to Reduce Physician Burnout in Graduate Medical Education: A Systematic Review

“…A framework developed to define the relationship between wellness, burnout, and resiliency during residency identifies wellness as a phenomenon that is ''more than a lack of impairment.'' 6 Wellness is ''a dynamic process involving self-awareness that results in healthy choices,'' which creates a balance between physical, emotional, and spiritual health, and perpetuates accomplishment and satisfaction, while offering a unique sense of protection from the often-overwhelming demands of medical training. 6 Burnout, as mentioned above, is a maladaptive syndrome that occurs due to prolonged occupational stress.…”

“…6 Wellness is ''a dynamic process involving self-awareness that results in healthy choices,'' which creates a balance between physical, emotional, and spiritual health, and perpetuates accomplishment and satisfaction, while offering a unique sense of protection from the often-overwhelming demands of medical training. 6 Burnout, as mentioned above, is a maladaptive syndrome that occurs due to prolonged occupational stress. Unlike wellness, burnout is associated with lack of control, loss of self-efficacy, increased frustration, detachment, and lower levels of compassion for the field and patients; it is often associated with depression and worsened patient outcomes.…”

“…Unlike wellness, burnout is associated with lack of control, loss of self-efficacy, increased frustration, detachment, and lower levels of compassion for the field and patients; it is often associated with depression and worsened patient outcomes. 6 Authors of this framework clearly discern among unique paths to resident burnout, wellness, and resiliency, showing that wellness and burnout require 2 distinct forms of programming and implementation to affect change in residency. Wellness itself acts as a coping skill not only to preserve residents' mental well-being, but also to help stave off the effects of burnout.…”

From origins to legacy: the fruits of Canadian medical education scholarship

“…Liora Berger and Nishardi Waidyaratne-Wijeratne propose a framework for thinking about wellness, burnout and resiliency in residency training. 6 These scholars noticed that although previous studies have tried various interventions to reduce resident burnout, the terms resilience and wellness were often conflated. Herein, they outline a framework for fostering resiliency in residents and recommend future work to study the its utility for enhancing the residency experience.…”